Thoracolumbar immobilization for trauma patients with torso gunshot wounds: is it necessary?

Wise Young · 09-04-2001, 12:45 AM

• Cornwell EE, 3rd, Chang DC, Bonar JP, Campbell KA, Phillips J, Lipsett P, Scalea T and Bass R (2001). Thoracolumbar immobilization for trauma patients with torso gunshot wounds: is it necessary? Arch Surg. 136 (3): 324-7. Summary: BACKGROUND: Previous studies have suggested that patients transported by emergency medical services (EMS) following major trauma had a longer injury-to-treatment interval and a higher mortality rate than their non- EMS-transported counterparts. HYPOTHESIS: There is little actual benefit of thoracolumbar immobilization for patients with torso gunshot wounds (GSW). DESIGN: Retrospective analysis of prospectively gathered data from the Maryland Institute for Emergency Medical Service Systems State Trauma Registry from July 1, 1995, through June 30, 1998. SETTINGS: All designated trauma centers in Maryland. PATIENTS: All patients with torso GSW. MAIN OUTCOME MEASURES: (1) A patient was considered to have benefited from immobilization if he or she had less than complete neurologic deficits in the presence of an unstable vertebral column, as shown by the need for operative stabilization of the vertebral column; (2) mortality. RESULTS: There were 1000 patients with torso GSW. Among them, 141 patients (14.1%) had vertebral column and/or spinal cord injuries. Two patients (0.2%) (95% confidence interval, -0.077% to 0.48%) required operative vertebral column stabilization, while 6 others required other spinal operations for decompression and/or foreign body removal. The presence of vertebral column injury was actually associated with lower mortality (7.1% vs 14.8%, P<.02). CONCLUSIONS: This study suggests that thoracolumbar immobilization is almost never beneficial in patients with torso GSW, and that a higher mortality rate existed among those GSW patients without vertebral column injury vs those with such injuries. The role of formal thoracolumbar immobilization for patients with torso GSW should be reexamined. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11231854> Department of Surgery, The Johns Hopkins Medical Institutions, 600 N Wolfe St, Osler 625, Baltimore, MD 21287-5675, USA. ecornwel@jhmi.edu

Wise Young · 09-04-2001, 12:51 AM

Interesting results:

1. Of 1000 patients with torso gunshot wounds, 14% had spinal cord or vertebral injury. There must be something about the spinal cord that attracts bullets.

2. Presence of vertebral damages was associated with half the mortality of those without vertebral injury. The vertebral column probably cushioned the bullet.

3. Formal thoracolumbar immobilization may not be beneficial...

Jr. · 03-21-2006, 01:07 AM

When reading articles here, there are several terms associated with spianl cord injurys such as thoracolumbar immobilization and others. Do you know of any free on the internet medical dictionary that deals with spinal cord injurys, or something of this nature?

Wise Young · 03-21-2006, 07:37 AM

Quote:

Originally Posted by Jr.

When reading articles here, there are several terms associated with spianl cord injurys such as thoracolumbar immobilization and others. Do you know of any free on the internet medical dictionary that deals with spinal cord injurys, or something of this nature?

Ask and ye shall be answered. Dictionaries such as http://www.websters-online-dictionary.org/ are pretty good.

Thoracolumbar is one of these hybrid terms that refer to the thoracic and lumbar spine.

Immobilization means to prevent movement.

Wise.

Jr. · 03-21-2006, 11:32 AM

Quote:

Originally Posted by Wise Young

Ask and ye shall be answered. Dictionaries such as http://www.websters-online-dictionary.org/ are pretty good.

Thoracolumbar is one of these hybrid terms that refer to the thoracic and lumbar spine.

Immobilization means to prevent movement.

Wise.

It seems so obvious now that you explained the meaning. Well this was only a quick example, the dictionary will provide help with all thee other terms i dont understand. Thanks Wise for the Info.

Bonita · 03-22-2006, 02:31 PM

Quote:

Originally Posted by Wise Young

Interesting results:

1. Of 1000 patients with torso gunshot wounds, 14% had spinal cord or vertebral injury. There must be something about the spinal cord that attracts bullets.

2. Presence of vertebral damages was associated with half the mortality of those without vertebral injury. The vertebral column probably cushioned the bullet.

3. Formal thoracolumbar immobilization may not be beneficial...

I have a T10 SCI due to a gun shot wound and I always wondered if they should have immobilized me. Although, I don't think they realized I had a spinal cord injury for quite some time. I know I was carried out on a tarp like thing because of where I was located in my home and then I also remember coming to in the ER and they had me sitting up taking x-rays.

I recently learned the path of the bullet that left me paralyzed. It entered my left chest traveled through the left lung, diaphragm and stomach then out through the stomach and diaphragm and lodged by my spine causing some damage to the spine. I guess that sort of supports the thought that there must be something about the spinal cord that attracts bullets. If the bullet would have gone straight through, I think the worst that would have happened was just a collapsed lung. But it didn't because of the type of bullet that was used. At the same time if the bullet had gone a little more to the right it would have probably gone through my heart.

I do consider myself fortunate to just be alive.

09-04-2001, 12:45 AM	#1
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Thoracolumbar immobilization for trauma patients with torso gunshot wounds: is it necessary? • Cornwell EE, 3rd, Chang DC, Bonar JP, Campbell KA, Phillips J, Lipsett P, Scalea T and Bass R (2001). Thoracolumbar immobilization for trauma patients with torso gunshot wounds: is it necessary? Arch Surg. 136 (3): 324-7. Summary: BACKGROUND: Previous studies have suggested that patients transported by emergency medical services (EMS) following major trauma had a longer injury-to-treatment interval and a higher mortality rate than their non- EMS-transported counterparts. HYPOTHESIS: There is little actual benefit of thoracolumbar immobilization for patients with torso gunshot wounds (GSW). DESIGN: Retrospective analysis of prospectively gathered data from the Maryland Institute for Emergency Medical Service Systems State Trauma Registry from July 1, 1995, through June 30, 1998. SETTINGS: All designated trauma centers in Maryland. PATIENTS: All patients with torso GSW. MAIN OUTCOME MEASURES: (1) A patient was considered to have benefited from immobilization if he or she had less than complete neurologic deficits in the presence of an unstable vertebral column, as shown by the need for operative stabilization of the vertebral column; (2) mortality. RESULTS: There were 1000 patients with torso GSW. Among them, 141 patients (14.1%) had vertebral column and/or spinal cord injuries. Two patients (0.2%) (95% confidence interval, -0.077% to 0.48%) required operative vertebral column stabilization, while 6 others required other spinal operations for decompression and/or foreign body removal. The presence of vertebral column injury was actually associated with lower mortality (7.1% vs 14.8%, P<.02). CONCLUSIONS: This study suggests that thoracolumbar immobilization is almost never beneficial in patients with torso GSW, and that a higher mortality rate existed among those GSW patients without vertebral column injury vs those with such injuries. The role of formal thoracolumbar immobilization for patients with torso GSW should be reexamined. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11231854> Department of Surgery, The Johns Hopkins Medical Institutions, 600 N Wolfe St, Osler 625, Baltimore, MD 21287-5675, USA. ecornwel@jhmi.edu

03-21-2006, 01:07 AM	#3
Jr. Senior Member Join Date: Mar 2002 Location: Phoenix , AZ Posts: 284	Nurse When reading articles here, there are several terms associated with spianl cord injurys such as thoracolumbar immobilization and others. Do you know of any free on the internet medical dictionary that deals with spinal cord injurys, or something of this nature? __________________ Thanks: {Art}

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09-04-2001, 12:51 AM	#2
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Interesting results: 1. Of 1000 patients with torso gunshot wounds, 14% had spinal cord or vertebral injury. There must be something about the spinal cord that attracts bullets. 2. Presence of vertebral damages was associated with half the mortality of those without vertebral injury. The vertebral column probably cushioned the bullet. 3. Formal thoracolumbar immobilization may not be beneficial...